- Email: [email protected]
Development of a Dietary Teaching Tool for American Indians and Alaskan Natives in Southern Arizona
GE M N o . 379
Development of a Dietary Teaching Tool for American Indians and Alaskan Natives in Southern Arizona ................................................................................... Linda Kautz Osterkamp, PhD, RD, FADA,* Nutrition Consultant, 1502 East Magee Rd, Tucson, A Z 85718; Tel/Fax: (520) 797-2230; E-mail: [email protected] Laura LmgstaB BSN, RN, CDE, US Public Health Service, Bethesda, MD
( J Nutr Educ Behav. 2004;36:272-274.) *Author for correspondence
Nutrition education is needed throughout the United States and the world as we face the growing epidemics of poor nutrition, obesity, and health issues resulting from them. To facilitate nutrition education ofthe public, the US Department of Agriculture (USDA) developed the Food Guide Pyramid as a teaching tool in 1992.'**To be effective, teaching materials must address the needs and desires of a variety of people; therefore, modification of a
basic educational tool is sometimes necessary to increase its relevance to the targeted audience. A major health issue for American Indians and Alaskan Natives in the United States is poor nutrition. American Indians and Alaskan Natives have been removed from or limited within native tribal lands for the past 2 centuries, thereby causing significant changes in the availability of traditional foods.3 Hunting, gathering,
Figure 1. First side of Southern Arizona American Indian Food Guide.
................................................................................................... 272
Journal of Nutrition Education and Behavior Volume 36 Number 5
and cultivation of crops historically were the primary methods of food acquisition for these populations. Now displacement and near-poverty living conditions are among the factors that preclude traditional methods of provision, which can lead to dependence on government-supplied commodity foods. Geographic constraints and local food environments impact food quality.M Because of the changed living environment, American Indian dietary patterns have evolved, combining indigenous and readily available These dietary changes are associated with the high prevalence of health threats for American Indian adults and ~ h i l d r e n .A~ study of 22 youths with non-insulin-dependent diabetes mellitus (NIDDM) under the age of 20 years from the Tohono O’odham Nation in southern Arizona showed that 82% were obese and had a strong family history of NIDDM.* Analysis of cardiovascular risk factors in another
southern Arizona group, the Pascua Yaqui Tribe, found that 86% of the adult population had risk factors, obesity being the most prevalent.’ It is essential to incorporate cultural perspectives and images into the material used to facilitate discussion of lifestyle and behaviors.’”-’* In focus groups conducted to gather input for design of educational material for the National Diabetes Education Program, 95% of American Indian and Alaskan Native participants from across the country expressed a strong preference for health education material presented in the context oftheir tribe or c ~ l t u r e . ’ ~ A study of Pascua Yaquis with foot ulcers, a common side effect of diabetes, found that strong cultural themes influenced health care, including spiritual practice^.'^ To improve the receptivity of persons living in southern Arizona to the USDA Food Guide Pyramid as a teaching tool, a food guide pyramid for American Indians was ~ 1 a n n e d . I ~
September October 2004
273
After a literature review, a southern Arizona American Indian food guide was drafted. T h s draft was critiqued by a local American Indian wellness group (N = 20). Discussions about dietary choices and behaviors were framed by a “food h e l d ” form that was distributed to each member of the grou to 76. I7 encourage fkee exchange of ideas. Comments shared were incorporated into the food guide. A group of diabetes educators (N = 10) reviewed the revised draft and offered changes to address weight management, portion control, and diabetes management guidelines. Both groups supported visual presentation of portion sizes and types of foods. Figures 1 and 2 show the front and back of the Southern Arizona American Indian Food Guide that was prepared following input from both groups. Specific adaptations include local foods identified by American Indians and Alaskan Natives that reflect interest in and knowledge of hunting and
information for this interpretationof the US. Department of Agriculture Food Guide hramid was contributed by the Armciation of American Indian Physicians. the American Dietetic Association. the American Diabetes Awxiatlon. National Cancer Institute. and the Southern Arizona Health Promotion Network. k M06 W -1
Figure 2. Second side of Southern Arizona American Indian Food Guide.
274
Osterkamp and Longstaff/GEM NO. 379 (J N u t r Educ Behav. 2004;36:272-274.)
gathering in this region. In Figure 2, gender differences in calorie levels were stressed in response to societal attitudes. Portion sizes for food address control of intake, and activity recommendations reflect the need for exercise to prevent o r manage diabetes mellitus and obesity. Fluid guidelines stress the need for adequate hydration in a desert setting.I8 Development of the Southern Arizona American Indian Food Guide demonstrates that a joint effort of health educators and a specific population can be effective in creating culturally relevant instructional materials. Evaluation of this adapted tool will continue in urban and rural settings.
REFERENCES 1. Davis CA, Britten P, Myers EF. Past, present, and future ofthe Food Guide Pyramid. J A m Diet Assoc. 2001;lOl: 881-885. 2. US Dept of Agriculture Web site. Available at: http://www.nutrition. gov/. Accessed October 21, 2003. 3. Mankiller W, Wallis M. Manki/lerA Chief and Her People. New York, N Y : St. Martin’s Press; 1993. 4. Hackenberg R. Changing diet of Arizona Indians. Journal of American Indian Education. 1964;3:27-32.
5. Wessel T. Agriculture, Indians, and American history. Agric History. 1976; 50(1):9-20. 6. Morland K, Wing S, Roux AD. The contextual effect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. Am J Public Health. 2002; 92: 1761-1768. 7. Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DJ. Increasing prevalence of type I1 diabetes in American Indian children. Diabetologia. 1998;4 1:904-910. 8. Coddington DA, Hisnanick JJ. Clinical characteristics of non-insulin dependent diabetes mellitus among southwestern American Indian youths. J Health Popul Nutr. 2001; 19:12-17. 9. Campos-Outcalt D, Ellis J, Aickin M, Valencia J, Wunsch M, Steele L. Prevalence of cardiovascular disease risk factors in a southwestern Native American tribe. Public Health R e p . 1995;110:742-748. 10. Walters KL, Simoni J M , EvansCampbell T. Substance use among American Indians and Alaska natives: incorporating culture in “indigenist” stress-coping paradigm. Public Health Rep. 2002;117(~~ppl l):S104-S117. 11. Fisher PA, Ball TJ. The Indian Family Wellness project: an application
of the tribal participatory research model. Prtw So‘. 2002;3:235-240. 12. Williamson E, Stecchi JM, Allen BB, Coppens NM. The development of culturally appropriate health education materials.] Nurs S t a f l D w . 1997; 13:19-23. 13. Roubideaux Y, Moore K, Avery C, Muneta B, Knight M, Buchwald D. Diabetes education materials: recommendations of tribal leaders, Indian health professionals, and American Indian community members. Diabetes Educ. 2000;26:290-294. 14. de Vera N. Perspectives on healing foot ulcers by Yaquis with diabetes. J Transcult Nurs. 2003;14:39-47. 15. Kautz Osterkamp L, Longstaff L. American Indian input creates a local culturally-relevant food guide pyramid [abstract]. ] Am Diet Assoc. 2001;101(suppl):A-102. 16. Goodwin M. A dietary history can be a “food shield.” C N I . 1977;7:4-5. 17. Kautz Osterkamp L. T h e dietary coat-of-arms opens dialog on motivation behind food choices [abstract]. J A m Diet Assoc. 2003;103(suppl): A-77. 18. Sawka MN, Montain SJ. Fluid and electrolyte supplementation for exercise heat stress. Am J Clin Nutr. 2000; 72(suppl 2):564S-5728.
Development of a Dietary Teaching Tool for American Indians and Alaskan Natives in Southern Arizona ................................................................................... Linda Kautz Osterkamp, PhD, RD, FADA,* Nutrition Consultant, 1502 East Magee Rd, Tucson, A Z 85718; Tel/Fax: (520) 797-2230; E-mail: [email protected] Laura LmgstaB BSN, RN, CDE, US Public Health Service, Bethesda, MD
( J Nutr Educ Behav. 2004;36:272-274.) *Author for correspondence
Nutrition education is needed throughout the United States and the world as we face the growing epidemics of poor nutrition, obesity, and health issues resulting from them. To facilitate nutrition education ofthe public, the US Department of Agriculture (USDA) developed the Food Guide Pyramid as a teaching tool in 1992.'**To be effective, teaching materials must address the needs and desires of a variety of people; therefore, modification of a
basic educational tool is sometimes necessary to increase its relevance to the targeted audience. A major health issue for American Indians and Alaskan Natives in the United States is poor nutrition. American Indians and Alaskan Natives have been removed from or limited within native tribal lands for the past 2 centuries, thereby causing significant changes in the availability of traditional foods.3 Hunting, gathering,
Figure 1. First side of Southern Arizona American Indian Food Guide.
................................................................................................... 272
Journal of Nutrition Education and Behavior Volume 36 Number 5
and cultivation of crops historically were the primary methods of food acquisition for these populations. Now displacement and near-poverty living conditions are among the factors that preclude traditional methods of provision, which can lead to dependence on government-supplied commodity foods. Geographic constraints and local food environments impact food quality.M Because of the changed living environment, American Indian dietary patterns have evolved, combining indigenous and readily available These dietary changes are associated with the high prevalence of health threats for American Indian adults and ~ h i l d r e n .A~ study of 22 youths with non-insulin-dependent diabetes mellitus (NIDDM) under the age of 20 years from the Tohono O’odham Nation in southern Arizona showed that 82% were obese and had a strong family history of NIDDM.* Analysis of cardiovascular risk factors in another
southern Arizona group, the Pascua Yaqui Tribe, found that 86% of the adult population had risk factors, obesity being the most prevalent.’ It is essential to incorporate cultural perspectives and images into the material used to facilitate discussion of lifestyle and behaviors.’”-’* In focus groups conducted to gather input for design of educational material for the National Diabetes Education Program, 95% of American Indian and Alaskan Native participants from across the country expressed a strong preference for health education material presented in the context oftheir tribe or c ~ l t u r e . ’ ~ A study of Pascua Yaquis with foot ulcers, a common side effect of diabetes, found that strong cultural themes influenced health care, including spiritual practice^.'^ To improve the receptivity of persons living in southern Arizona to the USDA Food Guide Pyramid as a teaching tool, a food guide pyramid for American Indians was ~ 1 a n n e d . I ~
September October 2004
273
After a literature review, a southern Arizona American Indian food guide was drafted. T h s draft was critiqued by a local American Indian wellness group (N = 20). Discussions about dietary choices and behaviors were framed by a “food h e l d ” form that was distributed to each member of the grou to 76. I7 encourage fkee exchange of ideas. Comments shared were incorporated into the food guide. A group of diabetes educators (N = 10) reviewed the revised draft and offered changes to address weight management, portion control, and diabetes management guidelines. Both groups supported visual presentation of portion sizes and types of foods. Figures 1 and 2 show the front and back of the Southern Arizona American Indian Food Guide that was prepared following input from both groups. Specific adaptations include local foods identified by American Indians and Alaskan Natives that reflect interest in and knowledge of hunting and
information for this interpretationof the US. Department of Agriculture Food Guide hramid was contributed by the Armciation of American Indian Physicians. the American Dietetic Association. the American Diabetes Awxiatlon. National Cancer Institute. and the Southern Arizona Health Promotion Network. k M06 W -1
Figure 2. Second side of Southern Arizona American Indian Food Guide.
274
Osterkamp and Longstaff/GEM NO. 379 (J N u t r Educ Behav. 2004;36:272-274.)
gathering in this region. In Figure 2, gender differences in calorie levels were stressed in response to societal attitudes. Portion sizes for food address control of intake, and activity recommendations reflect the need for exercise to prevent o r manage diabetes mellitus and obesity. Fluid guidelines stress the need for adequate hydration in a desert setting.I8 Development of the Southern Arizona American Indian Food Guide demonstrates that a joint effort of health educators and a specific population can be effective in creating culturally relevant instructional materials. Evaluation of this adapted tool will continue in urban and rural settings.
REFERENCES 1. Davis CA, Britten P, Myers EF. Past, present, and future ofthe Food Guide Pyramid. J A m Diet Assoc. 2001;lOl: 881-885. 2. US Dept of Agriculture Web site. Available at: http://www.nutrition. gov/. Accessed October 21, 2003. 3. Mankiller W, Wallis M. Manki/lerA Chief and Her People. New York, N Y : St. Martin’s Press; 1993. 4. Hackenberg R. Changing diet of Arizona Indians. Journal of American Indian Education. 1964;3:27-32.
5. Wessel T. Agriculture, Indians, and American history. Agric History. 1976; 50(1):9-20. 6. Morland K, Wing S, Roux AD. The contextual effect of the local food environment on residents’ diets: the atherosclerosis risk in communities study. Am J Public Health. 2002; 92: 1761-1768. 7. Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DJ. Increasing prevalence of type I1 diabetes in American Indian children. Diabetologia. 1998;4 1:904-910. 8. Coddington DA, Hisnanick JJ. Clinical characteristics of non-insulin dependent diabetes mellitus among southwestern American Indian youths. J Health Popul Nutr. 2001; 19:12-17. 9. Campos-Outcalt D, Ellis J, Aickin M, Valencia J, Wunsch M, Steele L. Prevalence of cardiovascular disease risk factors in a southwestern Native American tribe. Public Health R e p . 1995;110:742-748. 10. Walters KL, Simoni J M , EvansCampbell T. Substance use among American Indians and Alaska natives: incorporating culture in “indigenist” stress-coping paradigm. Public Health Rep. 2002;117(~~ppl l):S104-S117. 11. Fisher PA, Ball TJ. The Indian Family Wellness project: an application
of the tribal participatory research model. Prtw So‘. 2002;3:235-240. 12. Williamson E, Stecchi JM, Allen BB, Coppens NM. The development of culturally appropriate health education materials.] Nurs S t a f l D w . 1997; 13:19-23. 13. Roubideaux Y, Moore K, Avery C, Muneta B, Knight M, Buchwald D. Diabetes education materials: recommendations of tribal leaders, Indian health professionals, and American Indian community members. Diabetes Educ. 2000;26:290-294. 14. de Vera N. Perspectives on healing foot ulcers by Yaquis with diabetes. J Transcult Nurs. 2003;14:39-47. 15. Kautz Osterkamp L, Longstaff L. American Indian input creates a local culturally-relevant food guide pyramid [abstract]. ] Am Diet Assoc. 2001;101(suppl):A-102. 16. Goodwin M. A dietary history can be a “food shield.” C N I . 1977;7:4-5. 17. Kautz Osterkamp L. T h e dietary coat-of-arms opens dialog on motivation behind food choices [abstract]. J A m Diet Assoc. 2003;103(suppl): A-77. 18. Sawka MN, Montain SJ. Fluid and electrolyte supplementation for exercise heat stress. Am J Clin Nutr. 2000; 72(suppl 2):564S-5728.